Optimal high dose rate brachytherapy fractionation scheme after keloid excision. A retrospective multicenter comparison of recurrence rates and complications

Publication date: Available online 4 November 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Eveline Bijlard, Gerda M. Verduijn, J.X. Harmeling, Homan Dehnad, Frank B. Niessen, Otto WM. Meijer, Marc AM. Mureau
Background and PurposeExtralesional keloid excision followed by brachytherapy is currently considered as the most effective treatment. However, the optimal brachytherapy dose and fractionation scheme is unknown and radiation may have considerable side effects. Because keloid formation is a benign condition, often in young patients, it is particularly important to minimize these adverse effects. Therefore, it is key to find the optimal radiation fractionation scheme for keloid treatment.Material and MethodsPatient cohorts from three centers treated with keloid excision followed by 2x9 Gy, 3x6 Gy, or 2x6 Gy high dose rate (HDR) brachytherapy were retrospectively compared regarding recurrence (after at least 12 months follow-up) and complications (after at least 1 month follow-up), using logistic regression analyses.ResultsA total of 238 keloids were treated. An overall full recurrence rate of 8.3% was found. After correction for confounders (sex, skin color, keloid location, keloid duration) no statistically significant differences in recurrence rates could be discerned between fractionation schemes. There were 12.8% major and 45.6% minor complications. Lower radiation dose resulted in significantly less complications (OR 0.35, p=0.015).ConclusionsAfter excision of resistant keloids, HDR brachytherapy with a biological equivalent dose around 20 Gy is recommended based on both low recurrence and complication rates.

Teaser

Keloid treatment with excision followed by brachytherapy is considered the most effective. However, the optimal fractionation scheme is unknown. Patient cohorts from three centers using 2x9 Gy, 3x6 Gy, or 2x6 Gy were analyzed. The scheme using 2x6 Gy had equally low recurrence and lower complication rates, showing a BED of 20 Gy is adequate in post-excisional HDR brachytherapy keloid treatment.


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